Universidade Federal do Rio Grande do Sul, Graduate Program in Psychiatry and Behavioral Sciences, Brazil; Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Brazil.
Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Faculty of Medicine FMUSP, University of São Paulo, Brazil.
J Am Acad Child Adolesc Psychiatry. 2021 Feb;60(2):286-295. doi: 10.1016/j.jaac.2019.12.008. Epub 2020 Jan 29.
To identify the most appropriate threshold for disruptive mood dysregulation disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community.
Trained psychologists evaluated 3,562 preadolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in 3 stages: symptomatic, syndromic, and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item, which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture preadolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology.
At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts, some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated nonoverlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%.
Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.
确定破坏性心境失调障碍 (DMDD) 诊断的最佳阈值，以及诊断规则的潜在变化对社区患病率水平的影响。
受过培训的心理学家使用发展和福利行为评估 (DAWBA) 对来自 2004 年佩洛塔斯出生队列的 3562 名青春期前/青少年进行了评估。临床阈值在 3 个阶段进行评估：症状、综合征和临床操作化。症状阈值确定了 DAWBA 每个项目中的反应类别，该类别将正常行为与临床指标区分开来。综合征阈值确定了需要捕捉具有高症状水平的青春期前/青少年所需的易激惹情绪和发作次数。临床操作化比较了结合易激惹情绪和发作来组合的 AND/OR 规则对损伤和精神病理学水平的影响。
在症状阈值上，大多数易激惹情绪项目在其最低反应类别中是正常的，而在最高反应类别中是临床显著的。对于发作，有些即使在轻度水平下也表示有症状，而有些在任何水平下都不表示有症状。在综合征水平上，7 个易激惹情绪和 8 个发作指标中的 2 个组合准确地捕捉到了具有高水平症状的个体集群。结合易激惹情绪和发作的分析描绘了 DMDD 的非重叠方面，为临床操作化中的 OR 规则提供了支持。最佳 DMDD 标准导致患病率为 3%。
结果为旨在为 DMDD 提供数据驱动和以临床为导向的操作性标准的举措提供了信息。
